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The original title for the album was 'Tight Wad Hill'.

The album title is a reference to Billie's state of mind during the writing of the album. Newly born, Joey, would keep him awake all night crying. This gave birth to some of the lyrics on the album too.

The album artwork is a painting called 'God Told Me To Skin You Alive' designed by Winston Smith who is also an insomniac. The band knew Winston through Tre who, according to Winston, one day called him and asked if he would like to do artwork for the band's next album. Billie and Tre went to his studio and chose ideas on what they'd like for the cover and 'God Told Me To Skin You Alive' was created. According to Winston there are three skulls in the painting, one representing each band member.1

A former fan wrote a letter to Green Day shortly after the release of the tape. The letter was posted on Green Day.net and had the unnamed fan complaining about the content of the cassette brought for an eight year old by his sixty year old grandmother. The letter can be read2. Billie, naturally, replied to the letter. His reply was also posted on Green Day.net and can be read3.